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Chest injuries are quite common in sports and motor vehicle accidents, and many of them cause rib fractures. Broken or cracked ribs can be very painful, but in most cases can be easily managed, unless they have penetrated into the vital organs. In many cases, fractured ribs heal on their own in a month or two, although the condition is often associated with sharp pain, which exacerbates with movement. The healing process can be augmented with limiting activity and avoiding further injury.

Another important activity that can really help is deep breathing. Fully expanding lungs using deep breathing exercises, coughing, and though incentive spirometry is very important and preventing atelectasis (or collapsed lung), which is a breeding ground for infection. A painful rib cage limits one’s ability to take full breaths, and coupled with bed rest, it can lead to atelectasis and pneumonia. Therefore, it is highly advisable to perform these activities to prevent atelectasis. Diminishing pain through over-the-counter painkillers (such as NSAIDs) can also help prevent atelectasis.

For the first 4 to 6 weeks, the patient is advised not to lift more than 10 pounds or push/pull heavy objects. They should also avoid vacuuming, mowing, etc. Of course, that includes participating in contact sports. They are advised to do plenty of walking and perform low-impact exercise and resume normal daily activities.

It is critically important to look out for the warning signs, which include difficulty breathing, blue-tinged lips, fever of 102°F or higher, coughing up blood or thick mucus. If any of these are experienced, one should go to the emergency room right away, as these are heralding signs of the typical complications of broken ribs – pneumonia, pleural effusion, or a punctured lung.

For severe pain, opioids may have to be prescribed, but they are avoided as much as possible. This is because opioids have very high addiction potential and it may become hard to get off them. Moreover, they cause sedation and entail many precautions – including falls, handling machinery, driving, etc. They must not be taken with alcohol or other sedatives or other anti-anxiety or recreational drugs. Constipation is a very common side effect of opioids, and patients who are prescribed opioids are advised to stay well-hydrated and even take a laxative or a stool softener if needed. Ice helps decrease swelling and pain, and may even help prevent tissue damage. Use an ice pack or put crushed ice in a plastic bag.

In some cases, surgery may be needed if multiple ribs are badly fractured. It is definitely indicated if there is a condition called flail chest, in which the broken ribs will need to be held together with plates and screws. Also, if there is a serious injury to adjacent soft tissue, such as an organ, nerve, or blood vessel, it will require surgical treatment. And the recovery process is contingent on the extent of the injury and the type of surgical treatment.

The wrist is subject to fractures due to falling with outstretched or flexed hand. This can happen in a car, bike, skiing accident or with certain other sports activities. There are two bones in the forearm including the radius and ulna. The radius is on the thumb side. A fracture of the radius near the wrist is called a distal radius fracture.

Splinting is one choice for immobilizing the fracture and is commonly used for wrist fractures, reduced joint dislocations, sprains, soft tissue injury, and post-laceration repairs. Splints are mainly to immobilize and protect the injured wrist, aid in healing and decrease pain. Splints are primarily used for extremity injuries. Good anatomical fracture alignment is important.

There are a variety of splints used to treat fractures of the wrist and forearm. The splint used depends on the location of the fracture. These splints include:

Volar short arm splint

Dorsal short arm splint

Single sugar-tong

Long arm posterior

Double sugar-tong

Long arm

There are two types of distal radius fractures called a Colles or Smith fracture. Determining the break depends on the angle at which the break occurs.

Colles fracture: results from a direct impact on the palm of the hand; a bump in the wrist results from the distal radius shifting toward the back of the hand.

Smith fracture is less common and can result from impact to the back of the wrist; a bump in the palm side of the wrist results when the distal radius shifts toward the back of the hand.

Wrist fracture symptoms include:

immediate pain when area is touched

bruising and swelling

deformity

Treatment for a distal radius fracture is dependent on several factors. For immediate treatment, a splint may be applied to reduce pain and provide some comfort. If the fracture is displaced it is put back into correct alignment under local anesthetic before application of the splint. Additional factors influencing treatment are:

The femur is the biggest and generally the strongest bone in the human body. Fractures take a long time to heal. Normal activities of daily living are impacted as it is the main bone used for walking and standing. Depending on the type of fracture and potential complications the impact will last a lifetime.

There are several types of fractures. Each has its own characteristics. Each fracture is dependent on the force that breaks the femur.

These types of fractures include:

stable fracture – pieces of bone line up

displaced fracture – bone is out of alignment

closed fracture – the skin remains intact

open fracture – bone punctures the skin

Fractures are classified by:

location – distal, medial, proximal

pattern – bone breaks in different directions (crosswise, lengthwise, in the middle)

skin and muscle damage

The most common femoral shaft fractures include:

transverse – straight horizontal break across the shaft

oblique – angled line across the shaft

spiral – spirals the bone shaft caused by a twisting force

open – bone or fragments stick through the skin; also known as a compound fracture; there is damage to tissues, tendons, and ligaments. High risk of complications.

comminuted – bone breaks into three or more pieces

Common symptoms noted with a femoral break include:

immediate severe pain

cannot bear weight

injured leg appears to be shorter and/or looks crooked

A femoral fracture is normally found in severe accidents such as an automobile accident. Elderly people are subject to femoral breaks from falling due to weak bones. Hip fractures are also common with the elderly.

Common complications from femur fractures are related to the following:

the bone must be set properly – there’s a chance injured leg may become shorter and can cause chronic hip and knee pain; poor alignment can be painful

peripheral injury – muscles, ligaments, and tissues can be damaged

surgical – infection or blood clots, common surgical risks

Compartment syndrome

On a special note: Compartment syndrome is caused when increased pressure inside a closed space, that compromises circulation and function of surrounding tissues. Temporary or permanent damage to muscles and nerves may result in temporary or permanent damage.

Compartment syndrome may be:

Acute – most often caused by trauma, generally more minor. Prompt diagnosis and urgent treatment are required.

Chronic – usually caused by exercise. Symptoms begin with recurrent pain and disability. These symptoms may subside when the cause (usually running) is stopped and returns when activity is resumed.

The bones have many blood vessels that help promote healing. With time, the body will regenerate and further promote healing. Practice caution to prevent a re-fracture.

Reverse shoulder replacement surgery differs from standard replacement because the ball and joint of the shoulder switch places. In essence, the socket rotates on the outer side of the ball. This is a complicated surgery warranted by certain conditions. It provides significant pain relief and helps improve range of motion of the joint, although after surgery there is some limitation.

The main reason for this complex procedure is arthritis but, there are other reasons as well:

the rotator cuff tendons are gone or torn.

Shoulder remains painful after a routine shoulder replacement

Fracture in the proximal humerus (nearest the joint)

bone is shattered or splits into pieces

tumor in the humerus shaft or the ball of the humerus

In the event of torn or missing rotator cuff tendons, a person is unable to lift the arm enough to be functional. There may or may not be pain but the main reason for replacement is to regain functionality and motion.

There are instances when the procedure is not advised. Individuals should avoid this procedure if:

The socket bone of the shoulder blade (scapula) is too deteriorated that implants cannot be attached with screws or a bone graft is needed before placement can be done

ongoing infection in the shoulder

previous infection – increases post-operative risk of infection

rotator cuff cannot be repaired

complex fracture of the shoulder

other treatments did not work (meds, rest, etc)

Surgical risks include bleeding, nerve damage, and possible infection. There may be surgical complications such as:

humerus or arm portion (the socket) can become dislodged from the ball (the shoulder blade part) and the prosthesis is “dislocated.”

infection

the arm portion of the prosthesis can make contact with the bone of shoulder blade in certain positions

tingling, numbness and weakness with nerve damage

Injury to blood vessels

scaring

conditions, such as blood clots in the legs (deep venous thrombosis)

pulmonary embolus

heart attacks and strokes

drug or anesthetic reactions

After surgery, several doses of antibiotics are given to reduce the risk of infection. Pain medication will help relieve pain. Most patients can eat a solid diet and get out of bed the day after surgery. Discharge to go home is on the second or third day after surgery.

Fracture stabilization is the use of a variety of processes to enhance the healing of bone fractures. There are several methods including surgical, non-surgical, minimally invasive (vertebroplasty, fusion, kyphoplasty). Fracture stabilization gives pain relief and prevents further damage to soft tissue and bone.

There are closed and open fractures. With open fracture surrounding tissues and bone are visible. Fractures may include one or more bones and can be a clean break or shattered into numerous pieces. Breaks are a traumatic injury to the bone, tissues, and individual.

There are five classifications of fractures. These include:

Greenstick – found in children, incomplete fracture where the bone is bent

Transverse

Oblique – pattern of curves and slopes

Comminuted – bone breaks into pieces

Impacted/Buckle Fracture – bone ends are driven into each other

In addition, a pathological fracture is due to bone weakness, stress, and hairline fracture.

The doctor will diagnose the type of fracture by physical exam, x-ray, and MRI.

With a stable fracture, minimal treatment is required. In a stable fracture, the bone just breaks in one place and is easier to fix.

An unstable fracture can result from a car accident, falls, and other high impact situations. They may be accompanied by other serious injuries as well. Surgery is always required to fix the fracture. Symptoms of an unstable fracture include:

excruciating pain

bone showing through the skin

swelling and numbness

Early stabilization leads to better outcomes, such as fewer complications, shorter hospitalization, and lower cost. However, it may be contraindicated if there are head injuries, internal injuries, and other risk factors.

There are a number of options including the following:

External fixation -Pins and rods are placed outside the extremity

Internal fixation – Fracture is aligned and plates and pins are placed to hold the pieces together

Ring fixator or Taylor Spatial Frame – used if there is a deformity to be corrected

An unstable fracture is a severe injury. It is normally treated with the bone reduction and the bone may still slip out of place. This makes it difficult for the bone to be realigned. The bone is shattered into fragments, and it may not be possible to put all the broken pieces back in place.

Arthroscopic surgery uses a tiny camera (arthroscope) to examine, diagnose and repair damaged tissues inside or around joint like the shoulder or knee. A small incision is made into the skin and the arthroscope is inserted into the area being examined. The number of incisions needed is determined by what needs to be done.

Benefits of arthroscopic surgery are smaller incisions and less damage. Some physicians prefer open surgery because the structures are visible to the naked eye. It depends on what needs to be done, the specific condition, and surgeon experience.

There are several shoulder conditions that are repaired with arthroscopy. They include:

Rotator Cuff tears

Shoulder instability – Labral tears

Shoulder bursitis

Bicep tendonitis

Frozen shoulder

AC joint arthritis

Bone spurs

Repair ligaments

Remove inflamed tissue or loose cartilage

recurrent shoulder dislocation

Less common repairs include nerve release, fracture repair, and cyst removal.

Following surgery, someone should drive you home. Drowsiness may be felt for two or three days following the surgery. Follow post-op guidelines once home.

Guidelines include:

wound care- keep the site clean and dry.

Pain control – apply ice during the first 24 hours to reduce swelling, take pain medications as prescribed, Do Not drink alcohol

return to activity per doctors instructions

Complications of arthroscopy are uncommon but, may include shoulder stiffness and prolonged rehabilitation. There is one rare complication called chondrolysis (damages cartilage) and can lead to frozen shoulder. Other possible complications include:

Infection

head or neck injury

excessive bleeding

blood clots

damage to blood vessels or nerves.

Rehabilitation plays a huge role in regaining use of the of the joint and resuming daily activities. An exercise program should aim at regaining shoulder strength and movement.

With more complicated repair, physical therapy will be ordered so a physical therapist can supervise the exercise program.

Depending on the health condition treated, recovery times vary. A minor repair may only require a sling and a short period of physical therapy. It will take longer to recuperate from a more complicated surgery. Full recovery could take several months of physical therapy. Healing is a slow process. Surgeons guidelines and a good rehabilitation plan are important for a successful outcome, as well as, personal participation in the healing process.

Due to the fact that shoulder surgery hurts less, patients tend to do more too soon. The area may feel fine but still needs adequate time to completely heal. Too much activity too soon can cause recurrence of the condition or other damage to repaired tissues.

The patella is one of three bones that make up the kneecap. It is covered in cartilage on the underside and is important in maintaining the strength of straightening the knee joint. A fracture is a break in the bone. A fracture usually happens when there is a direct fall onto the kneecap.

A fracture like this can also damage the underlying soft tissue and the skin and result in an open fracture. A fracture can also occur when the quadriceps muscles contract but the knee is straight. When the muscle pulls forcefully the patella can fracture.

Sometimes the patella can fracture with a minor injury, but this is often a result of weak bones which can be caused by osteoporosis.

Names of fractures include:

eccentric

pathological

open fracture

Patella fractures can be severely painful and make it difficult to walk.

Signs of a patella fracture include:

severe pain

swelling and bruising on the front of the knee. After a few days, swelling and bruising may extend down the leg.

Inability to lift foot; straight leg lift is used in diagnosing this injury.

With palpation a break is felt; This may not be possible if there is considerable swelling.

Treatment includes an exam in the emergency room and an x-ray to determine how bad the break is, as well as, determine the type of break. One critical factor is the ability to do a straight leg raise from a laying position.

This tests the quadriceps muscle and its attachment to the shin bone (tibia). A separation of the quadriceps tendon, patella and/or the patella tendon cause the inability to lift the leg. If the leg can be lifted then non-surgical treatment could be possible in order to set the fracture.

Knee swelling is common and is from the bleeding from the fractured ends of the bone. If there is a large amount of bleeding then an aspiration would be done to remove the blood resulting in pain relief. In addition, a knee immobilizer will decrease the discomfort from the injury.

Minimally displaced fractures or non-separated fractures can usually be treated without surgery. An immobilizer or a straight leg cast may be sufficient treatment.

in some cases, a piece can be removed ( a smaller fracture or fragments)

A common complication of patella fracture surgery is the metal implants can become painful especially when able to kneel. Often there is a second surgery to remove the hardware. This can be done a year after the first surgery.

An important aspect of surgery is to repair the cartilage to prevent the development of arthritis of the knee joint. Damage to the knee joint cartilage can result in a higher chance of arthritis in the joint.

Other possible complications may include:

infections

failure of the hardware to hold pieces in place

the fracture does not heal

kneecap pain

possibly knee arthritis

Rehab will be needed once the kneecap has healed sufficiently as the knee is kept straight initially to allow healing. Being able to move the knee will depend on the strength of the repair but gentle movement may begin within the first few weeks after surgery.

Let’s discuss what a closed fracture is and then look at the list of treatment options. Be open to choosing the best healing protocol for you!

Closed fractures are classified as “simple fractures” that do not puncture the skin. Although the skin is not penetrated, soft – tissue injury can be acute and alternate treatments will be offered. In some cases, surgical procedures may be imminent.

You are at greater risk for a closed fracture if you are elderly, have osteoporosis, smoke or consume excessive amounts of alcohol (which makes bones brittle), steroid use, or lengthily resting periods (which make bones stiff – causing increased risk of fractures).

Please note – not all closed fractures require an intervention. Some can heal on their own, over time.

It is best to know which fracture treatments are available and which ones you prefer before making an informed decision.

When our doctor’s access treatment options, we look at these factors; age, what does our patient prefer and surgeon preferences (if need be).

Orthopedic doctors vary in their responses as to what form(s) will be best for your closed fracture. Patients can appear to be in shock, so first, we ease their minds with simple reassurance and inspiration. Next, we elevate the area (if possible) to reduce swelling and throbbing, along with keeping it still to prevent any additional damage. We are extremely careful not to irritate existing injuries and will need to take X – Rays to ensure the extent of damage. Doctors take into consideration the severity and recommend accordingly, avoiding surgery (if possible).

Some of the most common forms of treatment options are below:

Disable Movement: some bone fractures do not require an intervention. We classify them as “stable” and they can be monitored without immobilization.

Slings or “Walking Boots” might just do the trick in properly healing your simple fracture, where no further treatment is necessary. When you force the fracture to stay stationary, for an extended period of time, you allow it enough of a grace period to heal.

Casts prevent further damage, hold bones in place and stabilize the alignment of the fracture.

Surgery is the last resort to fixing a closed fracture and would be utilized in extreme cases only unless pain is unbearable at the wound site.

Our patients have many good things to say about our caring staff and state of the art facility.

“When I considered total knee replacement, like most people, I was anxious, but when I met Dr. D, he was very reassuring. I did not feel rushed during our discussion or when scheduling surgery. My surgery went very well. I was up and walking soon. I am walking my dogs again and feeling stronger in both legs. I have respect for Dr. D not only as a surgeon but as a kind and caring person.” Debbie R., Phoenix

Our staff is dedicated to providing the best care for you and your injury.

Feeling a bit under the weather, during times of physical impairment?Have you ever wondered if these midday blues will ever go away? You might be asking yourself, what is the problem with me? This is all normal during times of physical pain and treatment.

You just had surgery or are going to have a surgical procedure and you feel anxious. You are nervous if the surgery will be successful or if you will ever feel the same again. Will you be able to bend the same, walk normally, eliminate the pain and recover in a timely manner? You have a right to ponder these unanswered questions.

Sometimes people don’t need advice or neurofeedback or a psychological evaluation. What people need is family and friends to support them through difficulties and to listen while you vent. It is very helpful to have people you care about understand your valid concerns.

When you face physical challenges and you must undergo a surgical procedure, it can bring about an onset of feeling anxious and potential depressive states.

What can I do about my emotional issues pre and post-surgery?

It is extremely difficult to relax, but this one is a big solution to your bouts of anxiousness. The old saying of mind over matter is powerful for the results that follow. Lay down in a serene environment and visualize something happy. When our thoughts are eased, our emotions remain calm as well.

It is also very beneficial to exercise self-care. For example, take a hot bath (if you can), listen to soothing music, watch a Netflix series, read a book, meditate, pray, call a trusted friend, and write in a journal.

It is beyond frustrating when you are physically unable to walk, exercise or take a regular shower. People internalize their aggravation and lack the coping skills to stabilize their moods and anxiety.

Part of the healing process prior to and after surgery is lovingly taking care of your mind, emotions and feelings, so you do not experience nerve-racking, uncontrollable episodes. What we think about, we bring about. We must learn to feed our mind positive words of affirmation and not negative ones, or we will become mentally exhausted.

The last resort would be to put a patient on a low dose of anti-depressant medication if they cannot learn to manage their emotions and become too stressed out. Having a surgical procedure is very stressful as well and learning to deal with the pain it brings. It is not easy to find the proper social support that is needed during fearful times. Worry takes over our once sound mind and produces negative side effects such as headaches, stomachaches, low sex drive, acne, decreased immune functioning and even suicidal thoughts.

Our biggest recommendation is to ASK for help and allow others to be there for you and let trained experts provide treatment, that will solve your issues.

FXRX employs the best medical staff to alleviate pain, but we are also here to assist in making sure you are mentally tranquil as well. If you have questions, please email us or request an appointment https://www.fxrxinc.com/blog.html.

Accidents happen all the time and people get injured for numerous reasons! Athletes fall while running, sports stars twist ankles or bash their knees in, the elderly tumble while shuffling in the driveway, kids fall off their bikes and crack an elbow, weapon mishaps occur to anyone not being careful, car accidents demolish organs on impact and freakish wounds are unstoppable.

Injuries are known as physical trauma. Injuries occur when outside forces cause damage to the body, in unexpected, harmful ways. Injuries can be life-threatening and be the foundation for much-added pain throughout your body.

Who is at risk for injuries and why?

Anyone that plays a sport has an increased risk for potential injuries to any part of their body. We know that accidents can occur to anyone, anywhere. Therefore, athletic gear is enforced. Kids are forced to wear helmets, cups, body armor, elbow and knee pads, as well as chest protectors.

The elderly are specifically at risk of breaking bones, fractures weaken bone areas or sprained wrists due to not having the same agile mobility as they had in their younger years. Also, osteoporosis is more likely to occur in older adults. Osteoporosis is defined as a medical condition where your bones are brittle, they become weak due to your body not making new bones fast enough, and this makes people easily prone to fractures.

Everyone is at risk for bodily harm in an unforeseeable accident with a firearm or automobile catastrophe. You can lower your risks by not drinking and driving, going the speed limit, wearing your seatbelt, not texting and driving, paying attention to the road and do not get distracted from other people in the car.

At FXRS Orthopedics & Bracing, we have a variety of treatment options, depending upon the severity of your injury and pain level.

We offer various knee therapy choices:

◻ Knee Arthroscopy (Knee Scope)

◻ Knee Replacement

◻ Cartilage Regeneration is done through a knee scope – to avoid a knee replacement

We also offer fracture treatment and bracing for of these types of injuries.

Our trained surgeons will devise a medical plan that is best for your personal situation. You are not just a number in our practice. Our doctors listen to your concerns and care about your road to recovery.

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Testimonials

When I considered total knee replacement, like most people, I was anxious, but when I met
Dr. D, he was very reassuring. I did not feel rushed during our discussion or when scheduling surgery. My surgery went very well, I was up and walking soon. I am walking my dogs again and feeling stronger in both legs. I have respect for Dr. D not only as a surgeon, but as a kind and caring person.

Debbie R., Phoenix

I could not be more pleased with this practice!! I brought my 4 year old son in with a broken arm and was given exceptional same day service. The entire staff was so kind, understanding, attentive, and professional.

The office manager Lindy is a dream! Dr. Dewanjee is fantastic! I have brought my son in for two unrelated incidents and he has treated him so kindly. My dad sees Dr. Dewanjee as well and is so impressed. He is truly a 5 Star Doctor and I am so appreciative to he and his staff.

Jill S.

"I would like to express my gratitude for the surgeries you performed on my knees. You did a wonderful job and thanks you now I can walk without pain. Prior to the surgery I was scared, and I am willing to share my positive experience with others to help them overcome any fears they might have of going through the surgery.

I sincerely appreciate everything you have done and wish you lasting success so that you may bring happiness to others!"

Abel Romero, Phoenix

"In January I was involved in a horse riding accident which left me with several broken bones including a badly fractured clavicle. As a Canadian I had heard horror stories about the American medical system; my experience, however, was wonderful.

Within 24 hours of the accident I had an appointment with an orthopedic specialist, Dr. Sumit Dewanjee. His staff was professional, friendly and caring, making the whole process of being a Canadian in the American medical system as simple as possible. They dealt with all the paperwork which made the situation much easier for me.

Dr. Dewanjee is a very personable and skilled professional. He laid out my options very clearly and recommended the surgery I ended up having. The surgery was very successful.

I was made to feel like a valued patient as Dr Dewanjee carefully and fully answered all my questions and concerns. I would highly recommend Dr. Dewanjee and his entire staff to anyone wanting excellent care and a successful surgical experience."

I had a significant shoulder injury and after Dr. Dewanjee performed my surgery, i was back to work in minimal time. His intelligence along with his experience and knowledge to correctly repair my injury was paramount.

If you have a shoulder or knee injury, I would recommend Dr. Dewanjee at FXRX more highly than any other doctor.

Thank you Dr. Dewanjee!

Jim M, Phoenix

"I have known Dr. Dewanjee for 3 years and am thankful for his surgical abilities. My first encounter was his operating on my broken hip followed by right and left knee replacements.

My successful surgeries have given me the ability to comfortably do what I love; swimming for an hour daily. I am able at 85 years old to live alone in my own home and take care of myself.

I would highly recommend Dr. Dewanjee because of his skill and compassion."

Irmgard Hatfield

"During my Freshman year of college I dislocated my shoulder during a basketball game. After being referred to Dr. Sumit Dewanjee I wouldn't ask for a better doctor. He listens to his patients with depth that insures security. He performed surgery on my shoulder. During my visits to his office, Dr. Dewanjee and his staff were very customer oriented and organized. Within six months I was playing basketball again. I would definitely recommend Dr. Dewanjee."